Healthcare Provider Details

I. General information

NPI: 1962875674
Provider Name (Legal Business Name): CANDICE LANELL BAIN MT-BC, PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2015
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1918 UNIVERSITY AVE STE 2B
BERKELEY CA
94704-3264
US

IV. Provider business mailing address

1918 UNIVERSITY AVE STE 2B
BERKELEY CA
94704-3264
US

V. Phone/Fax

Practice location:
  • Phone: 510-548-9716
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number12038
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35340
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number35340
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: